Audit
 

By Mr. Zaher Toumi , Dr. Suzanne Lawson
Corresponding Author Mr. Zaher Toumi
General Surgery- Pennine Acute Hospitals NHS Trust, - United Kingdom OL1 2JH
Submitting Author Mr. Zaher Toumi
Other Authors Dr. Suzanne Lawson
Tameside General Hospital, - United Kingdom

SURGERY

Nutrition, Surgery, General Surgery, Outcomes

Toumi Z, Lawson S. Nutritional Screening in a District Hospital in the Greater Manchester Area. WebmedCentral SURGERY 2011;2(9):WMC002188
doi: 10.9754/journal.wmc.2011.002188
No
Submitted on: 12 Sep 2011 04:19:47 PM GMT
Published on: 13 Sep 2011 06:27:03 PM GMT

Abstract


Background and objectives:
National guidelines state that nutritional screening should take place for all hospital inpatients on admission and should be repeated weekly. Nutritional screening should include measuring the patient's weight and BMI and asking about any unintentional weight loss. We aimed to find out if nutritional screening was takes place at our district hospital and how useful that screening is.

Methods


We included all patients who were admitted to the surgical wards at a district hospital in Greater Manchester over a three-week period in 2010 in our audit. We checked whether these patients underwent initial and ongoing nutritional screening. We compared the group which had some form of nutritional screening with the group which did not have any nutritional screening in regards to length of stay and haematological and biochemical markers of hydration and nutritional status.

Results


One hundred and thirty nine consecutive patients were admitted during the audit period. 50.4% were males (n=70) and 49.6% were females (n=69). Median age of patient was 56 (range 18 - 90). Median length of stay was 2 days (range 0 - 52). Length of stay in hospital was three days or less for 91 patients and only 48 patients stayed more than 3 days.
Excluding patients who stayed three days or less in hospital, 65% of patients had some form of nutritional screening during their stay in hospital (31 out of 48).
Excluding patients who stayed three days or less in hospital, patients who had screening stayed in hospital longer than those who did not have any screening (7 days vs. 5 days, p=0.027).
Among the group, which stayed 4 to 7 days in the hospital, there was no biochemical or haematological evidence of improvement in the hydration or nutritional status of patients who had nutritional screening.
Similarly, among the group which stayed more than 7 days, there was also no biochemical or haematological evidence of improvement in nutritional state of those who had nutritional screening.

Discussion


When comparing the group that had no nutritional screening to the group which had some form of nutritional screening, there was a significant difference in length of stay between the two groups (less in those who didn't have nutritional screening). This could be interpreted as a worsening of outcomes following nutritional screening. However, it might be caused by an increased chance to have some form of nutritional screening performed if patients stayed in hospital for longer. Apart from the previous, there was no difference in outcomes between the two groups.

Conclusions


Nutritional screening for surgical patients at our district hospital, in its current format, is inadequate. It is not universal and when it is done, it is frequently incomplete. In its current format, it does not seem to lead to an improvement in hydration or nutritional status.

Source(s) of Funding


Neither sough nor received

Competing Interests


None

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